Extubation

Extubation

General

• There should be two licensed care givers must be present in room to perform procedure
• Just prior to the removal of the airway a time out procedure needs to be done and witnessed by two licensed care givers (RT / RN / MD)

Extubation is warranted when:

• The patient should be capable of maintaining a patent airway andadequate spontaneous ventilation. As well as not requiring high levels of positive airway pressure to maintain normal arterial blood oxygenation
• Patients in whom further medical care is considered and explicitly declared futile may have the endotracheal tube removed despite continuing indications for the artificial airway
• Acute artificial airway obstruction mandates immediate endotracheal tube removal if the obstruction cannot be cleared rapidly

Equipment needed for Extubation

• Adhesive remover
• Oxygen modality whether NC or Simple mask
• Suction
• Pulse Oximeter/monitoring
• Bag and mask
• Intubation equipment, and racemic epi neb should be readily available

Steps for Extubation

1. Assure the procedure is indicated and ordered
2. Extubation Readiness form has been completed by MD and RT
3. Take a time out:
   • Confirm written order with another licensed health care professional
   • Confirm patient identification
4. Assemble any necessary equipment
5. Support the patient’s respirations and oxygenation status
6. Suction the endotracheal tube, oropharyngeal airway and above the endotracheal tube cuff
7. Loosen and prepare to remove the endotracheal tube securing device(s)
8. Deflate endotracheal tube cuff completely if applicable
9. Gently and swiftly remove the endotracheal tube from the airway at the end of full inspiration
10. Encourage patient to cough and expectorate (suction orally if necessary)
11. Administer oxygen therapy as indicated
12. Closely assess the patient for signs of airway compromise